社会人口学因素会影响全膝关节置换术后的出院时间。
Socio-demographic factors impact time to discharge following total knee arthroplasty.
作者信息
Ihekweazu Ugonna N, Sohn Garrett H, Laughlin Mitzi S, Goytia Robin N, Mathews Vasilios, Stocks Gregory W, Patel Anay R, Brinker Mark R
机构信息
Fondren Orthopedic Group, Houston, TX 77030, United States.
Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX 77030, United States.
出版信息
World J Orthop. 2018 Dec 18;9(12):285-291. doi: 10.5312/wjo.v9.i12.285.
AIM
To determine social, logistical and demographic factors that influence time to discharge in a short stay pathway (SSP) by following total knee arthroplasty (TKA).
METHODS
The study included primary TKA's performed in a high-volume arthroplasty center from January 2016 through December 2016. Potential variables associated with increased hospital length of stay (LOS) were obtained from patient medical records. These included age, gender, race, zip code, body mass index (BMI), number of pre-operative medications used, number of narcotic medications used, number of patient reported allergies (PRA), simultaneous bilateral surgery, tobacco use, marital status, living arrangements, distance traveled for surgery, employment history, surgical day of the week, procedure end time and whether the surgery was performed during a major holiday week. Multivariate step-wise regression determined the impact of social, logistical and demographic factors on LOS.
RESULTS
Eight hundred and six consecutive primary SSP TKA's were included in this study. Patients were discharged at a median of 49 h (post-operative day two). The following factors increased LOS: Simultaneous bilateral TKA [46.1 h longer ( < 0.001)], female gender [4.3 h longer ( = 0.012)], age [3.5 h longer per ten-year increase in age ( < 0.001)], patient-reported allergies [1.1 h longer per allergy reported ( = 0.005)], later procedure end-times [0.8 h longer per hour increase in end-time ( = 0.004)] and Black or African American patients [6.1 h longer ( = 0.047)]. Decreased LOS was found in married patients [4.8 h shorter ( = 0.011)] and TKA's performed during holiday weeks [9.4 h shorter ( = 0.011)]. Non-significant factors included: BMI, median income, patient's living arrangement, smoking status, number of medications taken, use of pre-operative pain medications, distance traveled to hospital, and the day of surgery.
CONCLUSION
The cost of TKA is dependent upon LOS, which is affected by multiple factors. The clinical care team should acknowledge socio-demographic factors to optimize LOS.
目的
通过跟踪全膝关节置换术（TKA）后在短期住院路径（SSP）中的出院时间，确定影响出院时间的社会、后勤和人口统计学因素。
方法
该研究纳入了2016年1月至2016年12月在一家高容量关节置换中心进行的初次TKA手术。从患者病历中获取与住院时间（LOS）延长相关的潜在变量。这些变量包括年龄、性别、种族、邮政编码、体重指数（BMI）、术前使用药物的数量、使用麻醉药物的数量、患者报告的过敏数量（PRA）、同期双侧手术、吸烟情况、婚姻状况、居住安排、手术行程距离、就业史、手术进行的星期几、手术结束时间以及手术是否在重大节假日期间进行。多变量逐步回归分析确定了社会、后勤和人口统计学因素对LOS的影响。
结果
本研究纳入了806例连续的初次SSP TKA手术患者。患者的中位出院时间为49小时（术后第二天）。以下因素会延长LOS：同期双侧TKA手术[延长46.1小时（<0.001）]、女性[延长4.3小时（=0.012）]、年龄[每增加十岁延长3.5小时（<0.001）]、患者报告的过敏情况[每报告一种过敏延长1.1小时（=0.005）]、手术结束时间较晚[结束时间每增加一小时延长0.8小时（=0.004）]以及黑人或非裔美国患者[延长6.1小时（=0.047）]。已婚患者[缩短4.8小时（=0.011）]以及在节假日期间进行的TKA手术[缩短9.4小时（=0.011）]的LOS缩短。无显著影响的因素包括：BMI、收入中位数、患者居住安排、吸烟状态、用药数量、术前使用止痛药物情况、到医院的行程距离以及手术日期。
结论
TKA的费用取决于LOS，而LOS受多种因素影响。临床护理团队应认识到社会人口统计学因素，以优化LOS。
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